DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20151378

Allopurinol inappropriate use in case of asymptomatic hyperuricemic patient causes fatal Allopurinol hypersensitive syndrome: lesson to all

Arvind Kumar, Dinesh Kansal, Usha Kumari Chaudhary, Ajay Sharma, Reena Sharma

Abstract


Allopurinol is used to treat hyperuricemia (HU) in a patient of gout. It is also used to prevent HU in a patient of hematological malignancies who are about to undergo chemotherapy. Allopurinol is usually well-tolerated but it occasionally induces hypersensitivity reactions that manifest after few months of therapy. Cutaneous reactions are pruritic, erythematous, or maculopapular eruptions. Rarely fatal toxic epidermal necrolysis or Stevens-Johnson syndrome may occur. Transient leukopenia or leukocytosis, eosinophilia and elevated transaminases may also occur. HU is not a disease in itself. Its level is highly variable in the general population. Uric acid level is influenced by many factors such as dietary intake of proteins, hypertension, and obesity. Only very rarely patients of AHU may progress to gout and renal stones. Not much data is available that support HU alone in an asymptomatic patient in later life shows the diseases which are associated with HU. Sometimes only lifestyle changes, diet restrictions, alcohol restrictions, and treatment of underlying acquired cause may correct HU. Here, we are presenting a rare case of allopurinol hypersensitivity syndrome in an AHU patient. Our aim is to raise awareness among physicians so that they avoid using unnecessarily allopurinol in AHU patients and also titrate the dose of allopurinol in patients of renal failure. Risk-benefit ratio must be considered in these patients before starting allopurinol.


Keywords


Allopurinol, Allopurinol hypersensitive syndrome, Asymptomatic hyperuricemia

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References


Vázquez-Mellado J, Alvarez Hernández E, Burgos-Vargas R. Primary prevention in rheumatology: the importance of hyperuricemia. Best Pract Res Clin Rheumatol. 2004;18(2):111-24.

Dincer HE, Dincer AP, Levinson DJ. Asymptomatic hyperuricemia: to treat or not to treat. Cleve Clin J Med. 2002;69(8):594, 597, 600-2 passim.

Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008;359(17):1811-21.

Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. Am J Med. 2007;120(5):442-7.

Khanna D, Fitzgerald JD, Khanna PP, Singh MK, Pillinger MH, Lee S, et al. American College of Rheumatology guidelines for management of gout Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64(10):1431-42.

Grosser T, Smyth E, Fitzgerald GA. Anti-inflammatory, antipyretic and analgesic agents; Pharmacotherapy of gout. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman and Gilman’ the Pharmacological Basis of Therapeutics. 12th Edition. New York, NY: McGraw Hill; 2011: 997.

Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239-45.

Trisha G. Drug prescription and self-medication in India: an exploratory survey. Soc Sci Med. 1987;25:307-18.

Gutierrez-Macias A, Lizarralde- Palecius E, Martinez-Odriozole P, Miguel-De la Villa F. Fatal allopurinol hypersensitivity syndrome after treatment of asymptomatic hyperuricemia. Br Med J. 2005;331:623-4.

Maekawa K, Nishikawa J, Kaniwa N, Sugiyama E, Koizumi T, Kurose K, et al. Development of a rapid and inexpensive assay for detecting a surrogate genetic polymorphism of HLA-B*58:01: a partially predictive but useful biomarker for allopurinol-related Stevens-Johnson syndrome/toxic epidermal necrolysis in Japanese. Drug Metab Pharmacokinet. 2012;27(4):447-50.

Kuo CF, Yu KH, See LC, Chou IJ, Ko YS, Chang HC, et al. Risk of myocardial infarction among patients with gout: a nationwide population-based study. Rheumatology (Oxford). 2013;52(1):111-7.

Palmer TM, Nordestgaard BG, Benn M, Tybjærg-Hansen A, Davey Smith G, Lawlor DA, et al. Association of plasma uric acid with ischaemic heart disease and blood pressure: mendelian randomisation analysis of two large cohorts. BMJ. 2013;347:f4262.

Lin KC, Lin HY, Chou P. The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. J Rheumatol. 2000;27:1501-5.